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Unmanipulated haploidentical versus HLA-matched sibling allogeneic hematopoietic stem cell transplantation in relapsed/refractory acute myeloid leukemia: a retrospective study on behalf of the ALWP of the EBMT

Bone Marrow Transplantation (2019) | Download Citation

Abstract

Refractory or relapsed acute myeloid leukemia (R/R-AML) has poor prognosis. Allogeneic hematopoietic stem-cell transplantation (HSCT) may provide cure in this scenario. We compared outcomes of HSCT from HLA-identical (HLA-id, n = 1654) sibling or haploidentical (Haplo, n = 389) donors in patients with R/R-AML, performed during the period 2007–2015. The Haplo group included patients receiving an unmanipulated graft (post-transplant cyclophosphamide, n = 278; in vivo T-cell depletion, n = 95; or both, n = 16). Median age at HSCT was 52 (range 18–74) years. Median follow-up was 16 and 22 months for HLA-id sibling and Haplo recipients, respectively (p = 0.11). Compared to MSD, Haplo HSCT were performed more recently (2013 vs 2011, p < 0.01), at longer interval from diagnosis (7 vs 5 months, p < 0.01), more frequently using bone marrow as stem cell source (47% vs 8%, p < 0.01) and with a reduced intensity conditioning regimen (50% vs 43%, p = 0.03). Engraftment was higher (93% vs 83%, p < 0.01) in HLA-id sibling. In multivariate analysis, Haplo HSCT was associated with lower GVHD/relapse-free survival, inferior LFS and OS and higher NRM, mainly due to a higher rate of infections (41% vs 25%, p < 0.01). For R/R-AML, HLA-id sibling donors remain the gold standard, when available, due to higher mortality in Haplo without significant gain in disease control.

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Acknowledgements

The authors thank Emmanuelle Polge from the office of the ALWP of EBMT.

Author contributions

GB, AR, and AN designed the study. AB and ML performed the statistical analysis. GB wrote the manuscript. AR and AN revised the manuscript and all the authors reviewed its final version. FC, JT, MS, Gem DB, JF, MTVL, AG, BA, RF, and MM were the principal investigators at the centers recruiting the highest number of patients for the study.

Author information

Affiliations

  1. Hematology Department, Hôpital Saint Antoine, Service d’Hématologie et Thérapie Cellulaire, Paris, France

    • Giorgia Battipaglia
    • , Myriam Labopin
    •  & Mohamad Mohty
  2. Hematology Department, Federico II University, Naples, Italy

    • Giorgia Battipaglia
  3. Acute Leukemia Working Party of EBMT, Paris, France

    • Ariane Boumendil
    • , Myriam Labopin
    • , Mohamad Mohty
    •  & Arnon Nagler
  4. Hospital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France

    • Myriam Labopin
    •  & Mohamad Mohty
  5. Hematology and BMT Unit, IRCCS Ospedale San Raffaele; University Vita-Salute San, Raffaele, Milano, Italy

    • Fabio Ciceri
  6. Department of Internal Medicine III, University Hospital of Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany

    • Johanna Tischer
  7. Department of Medicine / Hematology and Oncology, University of Muenster, Muenster, Germany

    • Matthias Stelljes
  8. Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany

    • Gerhard Ehninger
  9. Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany

    • Dietrich Beelen
  10. University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg, Germany

    • Jürgen Finke
  11. Ospedale San Martino, Department of Haematology II Genova, Genova, Italy

    • Maria Teresa Van Lint
  12. Hannover Medical School, Department of Haematology, Hemostasis, Oncologyand Stem Cell Transplantation, Hannover, Germany

    • Matthias Eder
  13. First State Pavlov Medical University of St. Petersburg, Lev Tolstoy St Petersburg, Russia

    • Boris Afanasyev
  14. Azienda Ospedaliero Universitaria di Udine, Division of Hematology, Udine, Italy

    • Renato Fanin
  15. Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children’s Hospital, Roma, Italy

    • Annalisa Ruggeri
  16. Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel

    • Arnon Nagler

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The authors declare that they have no conflict of interest.

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Correspondence to Giorgia Battipaglia.

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https://doi.org/10.1038/s41409-019-0459-7